Scientific editor: Volkov AA, endocrinologist, practical experience since 2015.
October, 2018.
Graves' disease - a disease characterized by enlargement of the thyroid gland and increase its function as a result of attacks by its own immune system. The resulting complex develops symptoms due to toxic effects of thyroid hormones on various organs and systems.
The predominant age of diffuse goiter - 20-50 years. The prevailing gender - female.
Causes
The main factor for the development of the disease is an inherited defect of immunity, which leads to the production of special protein - autoantibodies bind to receptors on thyroid cells - it causes an increase in prostate and thyroid stimulating hormone gland. In some cases, Graves' disease develops after acute infectious diseases, stress impacts.
Manifestations of diffuse goiter
Complaints of general weakness, irritability, nervousness, and mild anxiety, insomnia, sweating, poor tolerance increased ambient temperature, heart rate, sometimes pain in the heart pricking or compressive nature, increased appetite, and, in spite of this, weight loss, diarrhea.
Infringements of cardiovascular activity in diffuse goiter manifested as increased heart rate (pulse rate, even during night's sleep for more than 80 per minute) increase in systolic and diastolic blood pressure, seizures arrhythmia. skin vessels are dilated, and therefore it is warm to the touch, wet. In addition, on the skin of some patients revealed vitiligo, darkening skin folds, especially where friction (neck, waist, elbow et al.), urticaria, traces of scratching (itchy skin, especially when joining of liver damage) on the skin of the head loss is observed hair.
Expressed shivering fingers. Sometimes hand tremors as expressed in diffuse goiter that patients find it difficult to fasten buttons, and handwriting changes characteristic sign of "saucer" (when in hand empty cup on a saucer makes a rattling sound as a result of the fine tremor hands).
Disorders of the nervous system manifested by irritability, anxiety, irritability, mood variability, loss ability to concentrate (the patient to switch quickly from one thought to another), sleep disorders, depression and sometimes even mental reaction.
In diffuse toxic goiter in most cases have characteristic changes (eye gloss et al.) From the eye. Eyes widened, giving the impression of an angry, surprised or scared look.
Diagnostics
Diagnosis of diffuse goiter carried endocrinologist. Patient first sent to study the basal level TSH using highly sensitive techniques. TSH Concentration in diffuse toxic goiter generally low (<0.1 mU / L). The concentration of T3 and T4, on the contrary, increased. Subclinical possible toxic goiter, wherein the level of T3 and T4 is stored, and TTG reduced.
Performed immunologic research. With the help of antibodies to TSH.
Also used instrumental methods. The patient may be administered thyroid ultrasound, scintigraphy, CT and MRI if necessary.
Treatment of diffuse goiter
The drug of choice for patients with diffuse toxic goiter is Tiamazol. The medicament is administered in an amount of 30-40 mg two steps. In most cases 4-6 weeks can be achieved euthyroid state in 90% of patients. On an ongoing basis the drug in high doses is not accepted, eventually switching to maintenance doziroku.
Widely used anti-anxiety drugs (bromo, valerian et al.).
In moderate to severe diffuse goiter used vitamins (A, C, B1, B2 B12, B15), cocarboxylase, ATP, calcium preparations.
Indications for the larger sizes are goiter (45 mL more) surgical treatment of diffuse goiter merkazolila intolerance, relapse after drug therapy, retrosternal location goiter.
Diet in diffuse toxic goiter:
sufficient content of protein, fat and carbohydrates;
replenishing vitamin deficiency (fruits and vegetables) and mineral salts (milk and milk products as a source of calcium salts);
limit foods and dishes that excite nernvuyu system (strong tea, coffee, chocolate, spices).
Forecast
In diffuse toxic goiter favorable prognosis. More than 60-70% of patients in remission occurs under the influence of merkazolila. Often remission occurs independently or as a result of non-specific therapy.
Numerous studies published in 1920-40 years., Show that under the influence of treatment, which can now be regarded as nonspecific (spa treatment, physiotherapy, balneotherapy et al.), advancing in the 80-90% remission. This can be attributed to indirect influence (immunomodulatory effects) of these factors on the immune system and the recovery of immune-neuro-hormonal relationship.
sources:
- Prof. EA Troshina, prof. NY Sviridenko. Federal guidelines for the diagnosis and treatment of toxic goiter. - FGBU "Endocrinology Research Center" Russian Ministry of Health; Medical University "First Moscow State Medical University. THEM. Sechenov "2014.
